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PERMIT APPLICATION
<br /> BUfLDING/MECHANICAL/ PLUMBING/SIGN/SPRINKLER/DEMOL(TION
<br /> CITY OF EVERETT PERMIT SERVICES �
<br /> 3200 CEQAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8890 � FAX 425-257-8857 �{E)evereEteps@everetfwa.gov� w�rnv.everet#wa.govlpermits
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<br /> PROJE�T�T ADDRESS: � �� PROPERTY TAX#:
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<br /> LEGAL for new construction: Short Plafi/subdivision Lot No. (aftach copy of iong legal description)
<br /> � �: ` = ' _. , `CONTACT INFORMATION;� �,, _..:. _ '
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<br /> OWNER NAME: � p� �J�Q„a��✓ TENANT NAME(if Commercial):
<br /> OWNEI2 MAILING ADDRESS: srReEr ��7 GI � �d r- ��.
<br /> CITY �'� � STATE � � ZIP ��Z� �
<br /> OWNER PHONE: �f�Z S� Z�� � � OWNER EMAIL: � �S e�'d(�,r y G.j.�o . C.�(.�
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<br /> � CONTRACTOR NAMH: �1(,�ti,e✓
<br /> CONTRACTOR ADpRESS: STREET
<br /> cirr srnrE ziP
<br /> CONTRACTOR PHONE: CONTRACTOR EMAIL:
<br /> CONTRACTOR LICENSE#(REQUiRED): CITY OF EV€RETT BUSINESS LICENSE#(REQUIRED):
<br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑OTHER(Pfease Specify) �
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<br /> CONTACT NAME: CONTACT PHONE: '
<br /> GONTACT EMAlL:
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<br /> t ,u'r�,w�;�Y' �� ` _..._.: :-. BU,.ILD1NGtPERMIT,AP�LICATION S ' ` ' ' � � 'k �
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<br /> Existing Use of Building: Contract Price of Work:$ . ��
<br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ClOther �
<br /> Buiiding Type: ❑SFR-Detached ❑SFR-Atfached . ❑Dupiex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial �
<br /> T e of Project: ❑New ClAddition ❑Remodei ❑Repair ❑T.1. ❑Si n �S rinkler ❑Demolition ❑Chan e of Use �
<br /> DESCRIPTION OF ORK:
<br /> �� �(`(9 D�� d
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> �` �MECH�INTGAL PERM�T APPlICATION,-._,: :::: „ �
<br /> , ..:h ,:.. ,..,,;�:: PLUMBING;RERMIT,APP,LICATION. ..:,;: `..,,:;:.:�,.,,�,
<br /> Type of Project: New Addn Alteration Repair Type of Projecf: _New _Addn Aiteration Repair
<br /> #of List of Fixiures #of Lisf of Fiztures #of Lisf of Fixfures #°f List of Fixtures
<br /> Fixtures Fixtures Fixtures Fixtures
<br /> A/C—Air Handling Units HearPump Toilet Backflow Preventer Qnside Bidg)
<br /> Forced Air Systems Unit Heater Bathtub Urinal �
<br /> Gas Piping 8oiler Lavatary(Wash Basin) Drinking Fountain �
<br /> Water Heater Refrigeration Shower Floor Drain �
<br /> Gas Fireplace Wood Stove Kitchen Sink 8�Disposal Grease Tra
<br /> Gas Range Ducting Dishwasher Roof Drains
<br /> Clofhes Dryer Hookups Other: Clothes Washer Medical Gas
<br /> Range Hood WaEer Heater Ofher:
<br /> Exhaust Fan Sink(Service/Bar/Mop/etc. Other:
<br /> � _�_z;�SpRINKLER'!SUPPRESSION SYSi'�M; ._
<br /> Number of Heads
<br /> ACKNOWLEDGEMENT.-I have reviewed this applicatiort and confirm the infarmation contained herein is true and correct Work done pursuanE fo this permif musf comply with
<br /> current federal,sfafe,and locallaw.The granting of a permit only autirorizes approved work and no deviafrons fherefrom.Deviations musf first be authorized in writing irom the
<br /> Building O�cial before being aufhorized under any circumstance.l am the owner,or!am authorized by the owner of this property to perform the work for which application Is made,
<br /> and I comply wi e Sfafe Contracfors Law 8.27 RCW and 296.200A WRQ
<br /> � City of Evere[t Official Use On1y
<br /> /'' .r �°t � PERMIT# � O� ��I�
<br /> �.., ,,..—�- i
<br /> �Owner/Aufhorized Age ture `�.. __.. D � (Revised 10/12/2015)
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